Decentralizing thought and action Starting from the problem

Theory without practice is as dangerous as practice without theory Begin from the problem; do not impose a solution without looking at the problem. I dont care what colour is the cat, as long as it catches mice pragmatic, evidence based, not ideological!!! The map is not the territory!!! Samakhya Dialogue of equals !!! If you do not do what you have to do, you will never be able to do what you want to do !!!!

A true partnership with States. Space for innovations. Distrust to trust. Community institutions as focus. A worker, an institution and an event in every village ASHA, VH&SC, VHND. Public health focus addressing local specific mortality and morbidity. Building capacities for local action. Recognizing the need for management skills.

Health Education

Maternal and Child Health Family Planning

Immunization against Infectious Disease

PHC
Nutrition & Food Security

Alma Ata Approach

Appropriate Treatment of Common diseases And injuries

Safe Water & Sanitation

Provision of essential drugs

Prevention & control of locally endemic diseases

Rejuvenate the Health delivery System Universal Health Care Access Affordability Equity Quality

Reduce IMR, MMR,TFR Improve Disease control

NRHM Main Approaches

COMMUNITIZE 1. Hospital Management Committee/ PRIs at all levels 2. Untied grants to community/ PRI Bodies 3. Funds, functions & functionaries to local community organizations 4. Decentralized planning, 5. Intersectoral Convergence MONITOR, PROGRESS AGAINST STANDARDS FLEXIBLE FINANCING 1. Setting IPHS Standards 2. Facility Surveys 3. Independent Monitoring Committees at Block, District & State levels

1. Untied grants to institutions 2. NGOs for public Health goals 3. NGOs as implementers 4. Risk Pooling money follows patient 5. More resources for more reforms INNOVATION IN IMPROVED HUMAN RESOURCE MANAGEMENT MANAGEMENT THROUGH CAPACITY

1. Block & District Health Office with management skills 2. NGOs in capacity building 3. NHSRC / SHSRC / DRG / BRG 4. Continuous skill development support

1. More Nurses local Resident criteria 2. 24 X 7 emergencies by Nurses at PHC. AYUSH 3. 24 x 7 medical emergency at CHC 4. Multi skilling

NRHM Illustrative Structure

Accredit private providers for public health goals 100,000 Population 100 Villages BLOCK LEVEL HOSPITAL Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services;

Health Manager Accountant Store Keeper

BLOCK LEVEL HEALTH OFFICE ---------------

Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics

30-40 Villages

CLUSTER OF GPs PHC LEVEL

3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests

5-6 Villages

GRAM PANCHAYAT SUB HEALTH CENTRE LEVEL

Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic

VILLAGE LEVEL ASHA, AWW, VH & SC

1 ASHA, AWWs in every village; Village Health Day Drug Kit, Referral chains

MMR

301 IN 2001-03

254 IN 2004-06 OVER ONE THIRD OF ANNUAL BIRTHS COVERED UNDER JSY. BELOW 200 NOW? 55 IN 2007 CLOSER TO 50 NOW? NEED TO STEP UP NEO NATAL AND HOME CARE FOR INFANTS. 2.7 IN 2007 IMPROVED FAMILY PLANNING PERFORMANCE SYSTEM STRENGTHENING GOOD FOR ALL PROGS. SYSTEM STRENGTHENING

IMR

58 IN 2005

TFR

2.9 IN 2005

MALARIA CASES

DOWN BOTH MORTALITY AND INCIDENCE IMPROVING IN LOW PERFORMING STATES

TB PERFORMANCE

KEY FINDINGS OF DLHS-III 2007-08 53.1% PHCs working on 24 hour basis 90.1% CHCs having 24 hour normal delivery services. 90.6% Sub Centres with ANMs. 19.2% PHCs with AYUSH doctors. 90.7% villages having JSY beneficiary. Full Immunization up to 54.1% Institutional deliveries up to 47%.

Human resources 7 lakh ASHAsand one lakh health workers under NRHM. Physical infrastructure 30% Sub Centre buildings, 20% PHCs, 75% CHCs, 75% District Hospitals being constructed/up graded Untied grants to all public institutions up to district level 1125 Mobile Medical Units across the country Over 10 States have Emergency medical system others with more ambulances. Doctors, drugs and diagnostics improvement. Public expenditure on health up from 1% of GDP in 2005 to 1.41% in 2008-09.

VHSc, PRIs, RKSs, DHMs, SHMs, MSG. Joint Bank Accounts for VHSC and Sub Centres. Registered Rogi Kalyan Samitis at PHC and above legal entity insurance, etc. Flexibility and adequacy of funding with accountability framework to ensure public action. Decentralized planning and implementation States, districts, blocks, villages deciding priority for public health action. System for procurement and logistics TNMSC. Improving Human Resource Management.

Financial Management FMR Programme Management SPMU, DPMU Data Management - HMIS Development of Standards IPHS Capacity development for public health public health management masters (PHFI) and diploma (PHRN IGNOU). Family Medicine programme CMC Vellore Professional Development Courses NIHFW, SIHFWs Accountability system Concurrent Evaluation, Community Monitoring, Performance Audit of CAG.

Decentralizing thought and action. Respecting local thought and action. Providing platform for sharing and learning. Intensive engagement in capacity development at all levels. Building systems that fosters innovations. Analytical feedback to States. Crafting convergent and credible platforms at all levels of care. PUTTING PEOPLES HEALTH IN PEOPLES HANDS TAKING CHARGE!!!!